Cherokee Nation Health Services offers our citizens some of
the best care available in Indian Country. Folks in northeast Oklahoma know
this, but recently we changed a few things that are creating more and better
health services for Cherokee families. I am proud to say we are reaping the
benefits of those efforts.
When someone comes to a Cherokee Nation health center and
needs something that our own clinics do not provide, like a knee replacement
for example, we send them to a specialist who is outside our network of
Cherokee Nation doctors and health care providers. Under that system, we
negotiate with insurance companies, hospitals, doctors and other vendors and
pay for those services. When patients have a primary insurance, Medicare
Part A and Part B, or Medicaid we are able to spend significantly less on the
required service and then spend those dollars on other patients.
In our recent history, the growth of referrals for care like
this have been dramatic. In 2004, our system averaged 87 of these referrals per
day. In 2017, those referrals had grown to an average of 410 per day. Because
of this growth in needed referrals, our programs have had to manage their
available resources. Some of the services that were being declined over the
past year include elective orthopedics and some of the related diagnostic tests
to those procedures.
To help address some of the recent limitations we had on
issuing referrals for outside costly, nonlife-threatening treatments, we
changed our records system, moving all patient health and medical records to a
digital format. When a patient comes in, our newly installed software
communicates with all payment systems, including IHS, private insurance
companies, Medicare and Medicaid.
The new efficiency has helped enable the tribe to collect
almost $9.5 million in the first three months of FY2018 in third-party billing.
Those additional funds will translate to more contract health dollars to
approve referrals for surgeries, MRIs and other related tests and help cover a
portion of more elective orthopedic referrals for our patients, who visited
Cherokee Nation Health Services more than 1.2 million times last year.
It also allowed us to measure quality outcomes and
efficiency, so doctors can earn more incentives when patients are treated and
get what they need. The strategic changes in the physician salary structure
reward our doctors for the quality and quantity of patients they see. Quality
is up across the board at Cherokee Nation Health Services, and we have more
funds dedicated to contract health needs.
I am proud of the strategic efforts we made to modernize our
health system and collect more from private insurance, Medicaid and other
third-party billing streams. The increase in collections also comes from our
successful outreach to sign up more patients for Affordable Care Act
marketplace insurance, SoonerCare and Medicare. These aggressive efforts to
enroll more Cherokee Nation Health Services patients have been successful and
are helping provide better health care services for our
people.
Our patients have more health needs than we could ever
possibly meet, so we are evolving with the times. There is constant growth in
health care, especially as the “baby boomer” generation matures and needs more
and more care. We want all our patients—Cherokees as well as other Natives in
northeast Oklahoma—to live healthier lives. To address these growing
challenges, we have been resolute in committing more gaming revenue dollars
specifically for contract health services, which now is an annual commitment of
about $7 million.
We feel that these changes will set Cherokee health on a
path for unprecedented financial security and open up more dollars for
specialty care, including visits to cancer doctors and heart doctors and a
return to covering a range of bone and joint surgeries.
Soon we will open the largest tribal health care facility
ever built in America. A topping out ceremony is planned on March 9, and in
2019, when the facility (located at the W.W. Hastings campus in Tahlequah) is
opened, it will house more health care specialists of our own and have two MRI
machines. Currently, Cherokee Nation does not have either of those specialty
services in-house, and we use contract health dollars to help pay for citizens
needing those medical services.
Patients
can get more information about additional coverage options by contacting their
patient benefits coordinator at any Cherokee Nation Health facility or visiting
www.CherokeeCare.com.
0 comments:
Post a Comment